The World Bank Report No: ISR2893 Implementation Status & Results Kazakhstan Health Sector Technology Transfer and Institutional Reform (P101928) Public Disclosure Copy Operation Name: Health Sector Technology Transfer and Institutional Reform Project Stage: Implementation Seq.No: 6 Status: ARCHIVED Archive Date: (P101928) Country: Kazakhstan Approval FY: 2008 Product Line: IBRD/IDA Region: EUROPE AND CENTRAL ASIA Lending Instrument: Specific Investment Loan Implementing Agency(ies): Ministry of Health Key Dates Board Approval Date 15-Jan-2008 Original Closing Date 30-Jun-2013 Planned Mid Term Review Date 31-Oct-2011 Last Archived ISR Date 08-Jan-2011 Effectiveness Date 15-Dec-2008 Revised Closing Date 30-Jun-2013 Actual Mid Term Review Date 31-Oct-2011 Project Development Objectives Project Development Objective (from Project Appraisal Document) To introduce international standards and build long-term institutional capacity in MOH and related healthcare institutions in support of key health sector reforms pursued by the Government of Kazakhstan in the context of the State Health Care Reform and Development Program. 1. Improved efficiency and equity of health expenditure and better financial protection for households in oblasts that implement a comprehensive package of healthcare financing and management reforms; 2. Improved quality and efficiency of medical care through the establishment of functioning systems/ institutions for clinical practice guideline development/dissemination and health facility accreditation, and through improved performance in the laboratory and blood transfusion systems; 3. Improved quality of medical graduates and improved ability to carry out medical research through upgrading the medical/pharmacological education and research systems and introducing international standards; 4. Improved efficiency and quality in health facility management through access to reliable, timely health information from a unified health information system; 5. Improved safety, efficacy, quality and affordability of drugs through reforms in pharmaceutical procurement, pricing, prescribing monitoring, information provision, benefit package design and quality control; and 6. Improved food safety and speedier WTO accession through the introduction of international sanitary and phytosanitary norms. Has the Project Development Objective been changed since Board Approval of the Project? Public Disclosure Copy Yes No Page 1 of 18 The World Bank Report No: ISR2893 Component(s) Component Name Component Cost Component A: Health Financing and Management 20.20 Public Disclosure Copy Component B: Health Care Quality Improvement 59.90 Component C: Reform of Medical Education and Medical Science 9.40 Component D: Health Information System Development 188.60 Component E: Pharmaceutical Policy Reform 4.20 Component F: Food Safety and WTO Accession 8.70 Component G: Project Management 4.60 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Satisfactory Moderately Satisfactory Overall Risk Rating Implementation Status Overview Overall implementation is proceeding well in most areas although efforts will be needed to expedite implementation in others. Notwithstanding the constraints encountered at the start of project implementation, progress has caught up in most of the 12 sub-components where implementation of activities is relatively on track. Despite two contracts, work under the component/sub-component has continued and progress is evident. Locations No Location data has been entered Results Project Development Objective Indicators Public Disclosure Copy Page 2 of 18 The World Bank Report No: ISR2893 Indicator Name Core Unit of Measure Baseline Current End Target Improved efficiency and equity of health Text Value Expenditure on: - utilities as a Expenditure on: (a) utilities as Expenditure on: (a) utilities as expenditure and better financial protection for proportion of total recurrent a proportion of total recurrent a proportion of total recurrent Public Disclosure Copy households in oblasts that implement a spending in hosp. that spending in hosp. that spending in hosp. should be comprehensive package of healthcare introduce package of reforms introduce package of reforms reduced by 10%; (b) financing and management reforms is TBD; - outpatient care as a will be available in 2012 outpatient hosp. care as a share of total expend. is following Comprehensive share of total hosp. expend. 25.6%. facility/provider/patient increased to 40% survey.; (b) outpatient care as a share of total expend. is 16%. Date 01-Oct-2008 15-Nov-2010 31-Dec-2013 Comments Expenditure on: (a) utilities as a proportion of total recurrent spending in hosp. that introduce package of reforms is 1.6%; (b) outpatient care as a share of total expend. is 29.9%. Improved quality & efficiency of medical care Text Value (a) No CPGs in place and no (a) List of 100 priority CPGs (a) At least 20 core CPGs through the establishment of functioning institution with capacity to identified, two MCH CPGs developed in 5 specialties and systems/institutions for clinical practice develop them. (b) No adapted. Activities to build reviewed; (b) Establishment guideline development/dissemination & health accreditation body and (c) no capacity ongoing but of independent accreditation facility accreditation health facilities have functional division of body, (c) which accredits at undergone accreditation to- responsibilities and least 20 public facilities at date. sustainability of processes for republican and oblast levels. CPG development implementation needs more clarity; (b) Accreditation Center in place since 2009, however, MOH decision is to locate accreditation function within RCHD as a Public Disclosure Copy department; (c) Upgraded accreditation standards are being tested in 5 hospitals, and 15 additional facilities to be tested in 2012. Date 01-Oct-2008 15-Nov-2010 31-Dec-2013 Comments Slow progress due to delays in CPG adaptation/ dissemination Page 3 of 18 The World Bank Report No: ISR2893 Indicator Name Core Unit of Measure Baseline Current End Target Improved quality of medical graduates & Text Value (a) Outdated curricula for (a) Post-graduate curricula for (a) New curricula for medical improved ability to carry out medical research medical and pharmaceutical General Medicine reviewed and pharmaceutical educ. Public Disclosure Copy through upgrading the medical/ educ.; (b) Participation rates and recommendations on the implemented in the 6 public pharmaceuticaleducation & research systems in training courses in EBM content of the curricula and univ.; (b) 100% participation & introducing international standards. centers is 0%; (c) No on how to approach their rates in training courses in physicians have been development provided, EBM centers; (c) 1500 licensed under new however, may not be possible physicians licensed under standards. to implement the program by new standards. 2014; (b) No progress in formally approving EBMCs by the MOH; however, most EBMCs conducting faculty training on EBM to varying degrees. The content of EBM training programs forstudents and faculty being reviewed under B2 and recommendations to be made for improvement based on international best practices; (c) Recommendations and capacity building plan provided for developing a certification framework and establishing Republican Knowledge and Skills Assessment Center; however, several more years needed before new certification system can be launched Date 01-Oct-2008 15-Nov-2011 31-Dec-2013 Comments Slow progress and risks of Public Disclosure Copy insufficient time for achieving targets. Page 4 of 18 The World Bank Report No: ISR2893 Improved efficiency and quality in health facility Text Value (a) There is no HMIS system (a) Implementation is (a) HMIS fully designed and management through access to reliable, timely in place; (b) 0% of staff are advancing according to plan approved for use by MOH; (b) health information from a unified health trained and able to use HMIS in two pilot oblasts, the 75% of key HMIS users fully information system. system. system platform is operational trained and able to use the Public Disclosure Copy and well underway with the system. basic functioning of registration of patients at the emergency, polyclinic and hospital levels. The sites are well equipped; (b) Training in current software use ongoing with 52.2% of all key users in pilot oblasts trained and able to use the system. Date 01-Oct-2008 15-Nov-2011 31-Dec-2013 Comments Partially on track with some delays in the introduction of standards and in the absence of a regulatory framework. Improved safety, efficacy, quality & affordability Text Value (a) Ratio of counterfeit drugs (a) n/a; (b) 58%, and (a) Ratio of counterfeit drugs of drugs through reforms in pharmaceutical TBD; (b) Out-of-pocket drug improved OPDBP submitted TBD; (b) 10% reduction in procurement, pricing, prescribing, monitoring, expenditure is 54.4%; (c) to GoK consideration; (c) Out-of-pocket drug expend.; information provision, BP design & quality Average retail and public Average retail and public (c) 10% reduction in Average control. procurement price for procurement price for retail and publicproc. price for selected drugs TBD; (d) No selected drugs TBD; (d) pre- selected drugs; (d) restructuring of final draft of National Restructured pharma. policy pharmaceutical policy sector. Pharmaceutical Policy, sector. including monitoring and evaluation indicators, to be discussed with broad audience on Nov.24-25, 2011. Date 01-Oct-2008 15-Nov-2011 31-Dec-2013 Comments (b) As per NHA 2008; (c) to Public Disclosure Copy be available in December 2010; other special surveys to establish baseline values not conducted yet. Improved food safety and speedier WTO Text Value (a) No safety norms in place; 26 sanitary norms and rules (a) Harmonization of 10 food accession through the introduction of (b) No technical regulations in and 25 technical regulations safety norms in accordance international sanitary and phytosanitary norms place. upgraded to international with int. standards; (b) standards for approval by Development and approval of MOH. 15 technical regulations; Date 01-Oct-2008 15-Nov-2011 31-Dec-2013 Page 5 of 18 The World Bank Report No: ISR2893 Comments Although overall Additional norms and implementation is well on technical regulations for track still regulatory harmonization identified; framework does not match revised target value to be Public Disclosure Copy WHO standards confirmed by the MOH following contract negotiations. Intermediate Results Indicators Indicator Name Core Unit of Measure Baseline Current End Target Establishment of a well-functioning Health Text Value No policy unit in place On track. Strategic Planning Establishment and operation Policy Unit Division established within of a well-functioning Health MOH Department for Policy Unit with at least five Strategic Development in staff possessing an 2009 (MOH Order No.229). appropriate skill-mix Due to institutional changes, functions on monitoring, analysis and formulation of proposals on health strategy and development transferred to the newly established 20- staff Center for Economic Research at Republican Center of Health Development (MOH Order No.212 of April 22, 2011). Implementation of capacity building plan for CER started in 2011. Date 01-Dec-2008 15-Nov-2011 30-Jun-2013 Comments Implementation of National Health Accounts Yes/No Value No No Yes Public Disclosure Copy Date 31-Dec-2008 07-Dec-2011 30-Jun-2013 Comments NHA 2007 & 2008 were Partially on track with new developed by MOH outside CER having NHA Unit, plan the Project scope, i.e., without for NHA institutionalization using new household/ developed, and development provider/client survey data of mechanisms for data collection, processing and analysis planned jointly with twining agency. Page 6 of 18 The World Bank Report No: ISR2893 Indicator Name Core Unit of Measure Baseline Current End Target improvement in allocative efficiency Text Value Delayed. Data on utilities 10 percent decrease in the expenditures by hospitals percentage of funds spent by Public Disclosure Copy included in the hospitals (excluding Comprehensive survey of outpatient facilities) on utilities facilities/providers/patients to (heat, electricity) in oblasts be conducted in 2012 & 2013. that introduce the full package of reforms Date 07-Dec-2011 30-Jun-2013 Comments Users perceived quality of care Percentage Value 70.00 80.00 80.00 Date 07-Dec-2009 07-Dec-2011 Comments Based on user surveys. Questions on users perceived increase by 10% Source: MOH Strategic Plan quality of care included in 2011-2015 Comprehensive facility/ provider/patient survey to be conductedin early2012& 2013. Improvement in providers autonomy Percentage Value 1.00 15.30 75.00 Date 31-Dec-2007 07-Dec-2011 20130631 Comments Less than 1% (26 facilities in 156 providers include 103 Not achievable 2007) public hospitals and 53 inpatient-substitute care providers. Target 75% (6,300 facilities) not achievableby 2013. Target in MOH Strategic Plan is 50 percent Improvement in facility planning Text Value 0 0 100% of newly-constructed/ major renovation hospitals Public Disclosure Copy based on new planning tool Date 07-Dec-2011 30-Jun-2013 Comments On track. New hospital planning standards developed based on international experience and assessment of health care needs in 10-15 year period. Master plans for first 5 oblasts developed based on new standards. Page 7 of 18 The World Bank Report No: ISR2893 licensing and accreditation of healthcare Text Value no licencing. Acreditation National health facility standards for licensing and facilities innitiated accreditation standards accreditation of healthcare developed and tested in 2009. facilities developed, adopted Accreditation system and implemented Public Disclosure Copy modernization plan developed in2010. Hospital accreditation standards upgraded in 2011 and their testing began. Date 12-Dec-2004 07-Dec-2011 20130631 Comments On track. Improvement of Blood Safety Text Value 75% of share of HCV cases Increased quality and confirmed by external effectiveness of donor internationally-accredited screening at selection and reference lab. laboratory screening Date 01-Dec-2011 30-Jun-2013 Comments Delayed. Increased share of voluntary to paid donor implementation of clinical practice guidelines Number Value 0.00 15.00 100.00 Date 07-Dec-2008 07-Dec-2011 Comments In progress but seems 60 percent of newly- unfeasible. A list of 100 developed CPGs priority CPGs identified and implemented including systematic adaptation of medical condition-based CPGs ordering and interpreting of can start. Two MCH CPGs laboratory tests adapted for Kazakhstan in March 2011 but approval by MOH Expert Committees pending, delaying implementation. The time frame for adaptation, Public Disclosure Copy dissemination, implementation of 60% of newly-developed CPGs seems unrealistic Page 8 of 18 The World Bank Report No: ISR2893 Laboratory network improvements Text Value not in place Delayed. Working group Laboratory network established and data restructuring plan developed collection on status of including equipment and HR laboratory service network standards, service profiles Public Disclosure Copy started in 2009. The selected and quality control firm did not agree to financial mechanisms terms and pulled out. Assignment to be re-designed and TORs revised. Date 01-Dec-2008 01-Dec-2011 20130631 Comments Improvement of medical education Text Value State standards in place for 6 Partially on track. Impossible New curricula for medical/ specialties of higher medical to develop an upgraded and pharmaceutical education and pharmaceutical standardized curricula for implemented, together with a education. General Medicine and unified testing system and General Surgery in updated/upgraded criteria for undergraduate and post- admission, by all public graduate studies within medical universities remaining contract period; instead recommendations on the content of the curricula and on how to approach their development provided by twining agency. Strategy for reform of medical education admissions developed; decisionby MOH on an admissions model to be adopted pending. Date 01-Dec-2008 01-Dec-2011 30-Jun-2013 Comments Public Disclosure Copy Page 9 of 18 The World Bank Report No: ISR2893 Improvement in continuous medical education Text Value On track. Rules for Regulatory/institutional/ qualification upgrade and re- financial framework training of medical and developed and approved for a pharmaceutical personnel sustainable, permanent Public Disclosure Copy developed and approved in system of continuing medical 2009. State standards and education instructions for development of methodological materials developed and approved in 2010 for residency, bachelor, master and doctorate programs, extended education. Twining agency developed in 2011 list of qualifications and requirements to teaching, admissions requirements and specifications for specialization, residency, master, and doctorate programs. Date 31-Dec-2008 01-Dec-2011 30-Jun-2013 Comments Utilization of IT technology Percentage Value 0.00 52.00 75.00 Date Comments On track with 52.2% (12275) 75 percent of key HMIS users of all key HMIS users in 4 fully trained and able to use pilot sites (23499) fully trained the system and able to use the system, including 100%(6762) in Astana, 97.9% (5513) in Akmola oblast. Public Disclosure Copy Indicator not sufficient to measure quality of IT services. Page 10 of 18 The World Bank Report No: ISR2893 Satisfaction with utilization of IT Text Value On track with preliminary 75 percent of staff who use 51.2% (according to a survey the HMIS report average or of health high levels of satisfaction facilities➃�➂�➃�➂�➃�➂�➃�➂�➃ Public Disclosure Copy �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ �➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂� ➃�➂�➃�➂�➃�¢ ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� Public Disclosure Copy ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂ staff who use the HMIS conducted in 2010). Questionsrelated to HMIS users➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃� �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ Page 11 of 18 �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ The World Bank Report No: ISR2893 Full HMIS package deployed in three oblasts Text Value Partial progress. Advanced Full HMIS package deployed plus Astana City implementation in two pilot in three oblasts plus Astana oblasts, but quality of City software is not at satisfactory Public Disclosure Copy level to meet international standards. IT equipment contracts for Karaganda and East-Kazakhstan oblasts are at stages of execution and tendering, respectively. Date 01-Dec-2011 30-Jun-2013 Comments Public Disclosure Copy Page 12 of 18 The World Bank Report No: ISR2893 Accreditation of medical education Text Value National standards for On track. 16 national experts International accreditation institutional accreditation trained at WFME on medical standards adopted on basic developed and approved education quality assurance medical education for medical based on WFME standards system and accreditation universities Public Disclosure Copy for basic medical education standards in 2009. 4 medical and tailored to Ministry of universities (Astana, East- Education and Kazakhstan, West- Science➃�➂�➃�➂�➃�➂�➃�➂�➃ Kazakhstan, Almaty) �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ accredited by NAC MOES in �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ 2010 for 5 years. �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ Recommendations provided �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ by twining agency in 2011 on �➂�➃�➂�➃�➂�à upgrading national �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ accreditation standards to �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ comply with international �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ WFME standards for basic �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ education. �➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃ �➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� Public Disclosure Copy ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃� �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ Page 13 of 18 �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ The World Bank Report No: ISR2893 Improvements of medical research Text Value Overall, significantly delayed Mechanism developed for the with twining agency starting prioritization and review of its work in January 2012; but medical research and the partially on track with priorities issuance of competitive Public Disclosure Copy for medical research defined grants, according to by MOH in 2010 and international principles methodological recommendations on ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃� �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂ �➃�➂�➃�➂�➃�➂�➃�➂�➃�¢ ➃�➂�➃�➂�➃�➂�➃� � ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� Public Disclosure Copy ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� ➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� Page 14 of 18 ➂�➃�➂�➃�➂�➃� The World Bank Report No: ISR2893 restructuring of the pharmaceutical policy Text Value Late start up, but progress Progressive restructuring of sector good with pre-final draft of the the pharmaceutical policy National Pharmaceutical sector as evidenced by Policy, including monitoring finalization and publication of Public Disclosure Copy and evaluation indicators, a national drug policy by 2010 developed and to be discussed with broad audience on Nov.24-25, 2011. Date 01-Dec-2011 31-Dec-2010 Comments delayed Drug approval system updated, based on Text Value Late start up, but progress Drug approval system international standards good with the National updated, based on Formulary (798 items) international standards by prepared based on 2009, including removal from international experience, the market of some recommendations for removal ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� of outdated drugs and ➃�➂�➃�¢ improved procedures for ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� selection of medicines to be ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� included, and approved by the ➃�➂�➃�➂�➃�➂�➃�➂ olderdrug Republican Formulary s➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃� Commission in 2011 ➂�➃� ➂�➃�¢ ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂�➃�➂�➃�➂� ➃�➂�➃�➂�➃�➂�➃�➂ by 2012 Date 01-Dec-2011 Comments Public Disclosure Copy Page 15 of 18 The World Bank Report No: ISR2893 Establishment of drug price regulations Text Value Late start up, but progress Establishment of drug price with revised MOH orders on regulations by 2009 that drug pricing rules and on caps decrease the average retail on prices of drugs procured and procurement price for Public Disclosure Copy within BBP (No.700 of selected drugs by 2010 Nov.12, 2009; No.733 of Nov.18, 2009; No.497 of Jul.3, 2010; price margin for outpatient drugs capped at 25% of approved ceiling price); conducted situation analysis of drug pricing and utilization; almost finalized baseline survey on government drug procurement prices, inpatient and outpatient prices and availability across 6 regions of the country, the affordability of standard treatments, and price components in the supply chain. Some deliverables on drug pricing shifted to 2012. Date 01-Dec-2011 31-Dec-2009 Comments Delayed Technical food regulations to international Text Value Recommendations provided Development and approval of standards on harmonization with 15 technical regulations to international requirements of international standards 25 technical regulations; their approval by MOH is pending. Date 01-Dec-2011 30-Jun-2013 Comments Public Disclosure Copy Decrease in out-of-pocket drug expenditures Percentage Value 54.00 44.00 Date 01-Dec-2011 30-Jun-2011 Comments Data not available. To be 10 % decrease completed in 2012. Page 16 of 18 The World Bank Report No: ISR2893 Harmonization of food safety norms and rules Text Value Recommendations provided Harmonization of 10 food in accordance with international standards on harmonization with safety norms and rules in international requirements of accordance with international 26 sanitary norms and rules standards Public Disclosure Copy for food industry; their approval by MOH is pending. Date 01-Dec-2011 30-Jun-2013 Comments Regulation of food standards and processing Text Value Recommendations provided Harmonize regulations with on revision of 10 legal and WTO standards regulatory documents according to international standards; their approval by MOH is pending. 22 food standards were received from Codex Alimentarius Commission Secretariat and provided to state standardizationbodies for upgrading national standards. Date 01-Dec-2011 30-Jun-2013 Comments Data on Financial Performance (as of 02-Dec-2011) Financial Agreement(s) Key Dates Project Loan No. Status Approval Date Signing Date Effectiveness Date Closing Date P101928 IBRD-48830 Effective 15-Jan-2008 02-Feb-2008 15-Dec-2008 30-Jun-2013 Disbursements (in Millions) Project Loan No. Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Public Disclosure Copy P101928 IBRD-48830 Effective USD 117.70 117.70 0.00 27.04 90.66 23.00 Disbursement Graph Page 17 of 18 The World Bank Report No: ISR2893 Public Disclosure Copy Key Decisions Regarding Implementation While the project as designed focused mostly on building capacity to develop policies through technical assistance and training, actual implementation of reforms was not envisaged. The PAD recognized that adjustments could be needed depending on the pace of the reforms and evolving needs. Given the good progress made so far, it was recognized that the project should shift its focus towards implementation of a number of key reforms envisaged under Salamatti Kazakhstan. This will be possible because of considerable savings attained in the procurement of both equipment and provision of technical assistance from projections made at appraisal. It was agreed that based on the priorities identified, MOH will work in the next two months (up to the end of January 2012) to elaborate/define the proposed scope of work, content, duration of tasks and estimated budgets. The Minister of Health indicated her intention to request the extension of the closing date of the Loan to coincide with the duration of Salamatti Kazakhstan which runs to December 31, 2015. Also, monitoring indicators as agreed at negotiations need to be amended to ensure that they can better measure both outcome and intermediate indicators and are aligned with new activities. The changes in indicators, addition of new activities, reallocation of funds among components and categories of expenditure, and extension of the closing date will need to be processed through a Project Restructuring. Public Disclosure Copy Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 18 of 18